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WHO group II anovulation (defined as anovulation associated with near-normal gonadotropin levels and normal follicular-phase estrogen levels) is most commonly caused by polycystic ovary syndrome (PCOS). To identify the best first-line pharmacologic treatment for WHO group II anovulatory infertility, investigators performed a network meta-analysis of 57 trials encompassing outcomes in 8082 women.
All pharmacologic treatments (i.e., clomiphene, letrozole, metformin, tamoxifen, clomiphene plus metformin, and gonadotropin injections) were superior to placebo for attaining ovulation and pregnancy. Compared with clomiphene alone, letrozole resulted in significantly higher rates of ovulation (odds ratio, 1.99), pregnancy (OR, 1.58), and live birth …